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Today's Date: OB/GUN PATIENT HEALTH HISTORY QUESTIONNAIRE A NAME: AGE: DOB: 1. Marital Status: I Single I Married I Long term Relationship I Divorced I Widowed 2. Reason for this visit: 3. Referring.

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Previous Obstetric History. A good starting point is to ask about number of children the patient has given birth to. Next, sensitively ask about miscarriages, stillbirths, ectopics and terminations.

Obstetric history. Patients should be asked to list all pregnancies and the outcome of each, with attention to whether the pregnancy was intrauterine or ectopic....Menstrual History. Age at menarche. ... Last menstrual period (LMP). ... Menstrual pattern and associated symptoms. ... Perimenopause/menopause.

For the gynecologic history, doctors ask about the problem prompting the visit, past and present menstrual periods, past pregnancies, sexual activities, and gynecologic symptoms, disorders, and treatments that the woman has had in the past.

We may also ask questions such as: Do you have irregular periods? How bad are your period cramps? Do you have any uncomfortable itching? Are you having sex? If you are having sex, do you use condoms? Are you using another form of birth control?

It is important to ask about pain, associated trauma (including domestic violence), fever/malaise, recent ultrasound scan results (e.g. position of the placenta), cervical screening history, sexual history and past medical history to help narrow the differential diagnosis.

Doctors in obstetrics and gynaecology (O&G) care for pregnant women and unborn children, and look after women's sexual and reproductive health.

You can ask questions about your body, growing up, and sex. You may also have certain exams and vaccinations. Your doctor may ask a lot of questions about you and your family. Some of them may seem personal, such as questions about your menstrual period or sexual activities (including vaginal, oral, or anal sex).

Presenting complaint Last menstrual period (LMP) - date of first day of bleeding. Cycle length and frequency - eg, 5/28, five days of bleeding every 28 days. Heaviness of bleeding. ... Presence or absence of intermenstrual bleeding (IMB). Presence or absence of postcoital bleeding (PCB). Age of menarche/menopause.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232